Contract Pharmacy Details

1875 LEXINGTON AVENUE CORP OF NEW YORK
DSH330240 HARLEM HOSPITAL CENTER (NYCHHC)

Covered Entity Details

Entity Name

HARLEM HOSPITAL CENTER (NYCHHC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330240

Entity Address

506 LENOX AVENUE
NEW YORK, NY 10037

Medicare Provider Number

330240

Participating Start Date

12/1/1992

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

1875 LEXINGTON AVENUE CORP OF NEW YORK

Pharmacy Address

D/B/A QUICK RX
1875 LEXINGTON AVENUE
NEW YORK, NY 10035-1003

Pharmacy Comments

Contract Details

Approval Date

10/18/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/12/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479

Contract Pharmacy Representative

Quick Rx Pharmacy Group
Elan Katz, CEO
(917) 733-4301

Signed By Date

10/18/2016

340B Drug Pricing Program Database